[Cardiac failure caused by intrapericardial chronic expanding hematoma 18 years after CABG]

Area of Science:

• Cardiology
• Thoracic Surgery
• Medical Imaging

Background:

• Chronic expanding hematoma (CEH) is a rare clinical entity, typically occurring in the thoracic cavity or muscles, characterized by slow, continuous expansion.
• CEH in the pericardial cavity following cardiac surgery is exceptionally uncommon, posing diagnostic and therapeutic challenges.
• This condition can mimic other intrapericardial masses, necessitating detailed imaging for accurate diagnosis.

Observation:

• A 64-year-old male, 18 years post-coronary artery bypass grafting (CABG), presented with heart failure symptoms including exertional dyspnea and fatigue.
• Computed tomography (CT) revealed a large intrapericardial mass severely compressing the left ventricle.
• The mass was diagnosed as an intrapericardial chronic expanding hematoma.

Findings:

• Surgical resection of the calcified epicardium and removal of the intrapericardial hematoma were performed.
• Post-operatively, the patient's heart failure symptoms significantly improved.
• No recurrence of the intrapericardial CEH was observed within one year of follow-up.

Implications:

• This case underscores the possibility of CEH occurring in the pericardial space long after cardiac surgery.
• Successful surgical management can lead to significant clinical improvement in patients with intrapericardial CEH.
• Long-term surveillance is crucial to monitor for potential late recurrence of this rare condition.